Tag Archives: conflicts of interest

Just in advance of the United Nations High Level Meeting on the Prevention and Control of Non-communicable Disease, a coalition comprising more than 140 nongovernmental and public health organizations has called on the UN to restructure the way in which the food and beverage industry has been involved in the policy negotiations.

Photo by Christian Cable / Wikimedia Commons

The Conflicts of Interest Coalition (COIC) describes itself as a group of “civil society organizations united by the common objective of safeguarding public health policy-making against commercial conflicts of interest through the development of a Code of Conduct and Ethical Framework for interactions with the private sector.”

The COIC sent a Statement of Concern to the President of the United Nations General Assembly and the UN summit’s facilitators, decrying the lack of clarity regarding the role of the private sector in public policy-making in relation to the prevention and control of non-communicable diseases (NCDs).

“Since the major causes of preventable death are driven by diseases related to tobacco, unhealthy diet, physical inactivity and alcohol drinking, we are concerned that many of the proposals to address NCDs call for ‘partnerships’ in these areas with no clarification of what this actually means. Public-private partnerships in these areas can counteract efforts to regulate harmful marketing practices,” the COIC wrote.

Calling industries “both part of the NCD problem and the solution,” the COIC believes industry should be involved in the implementation of policy but not its development. To that end, the group’s Statement offered two proposals:

First, a change in the nomenclature of nongovernmental organizations (NGOs) to distinguish between those that are industry-supported and those that are strictly civil society: “Business-interest-not-for profit organizations (BINGOs) and public interest nongovernmental organizations (PINGOs).

Second, a “code of conduct” that sets out a clear framework for interaction with the food and beverage industry and managing conflicts of interest, differentiating between policy development and implementation.

“We ask for the UN to consider our comments and take them into account for the UN High Level Meeting in September,” the COIC wrote in the Statement, a version of which was published Sept. 16 online in The Lancet.

Indeed, food industry lobbying is believed to have played a role in the removal of specific targets and indicators for reductions in salts, sugars, and saturated fats from earlier versions of the Political Declaration that will be voted on at the UN High-Level meeting, but it is probably too late to change that document since the vote is expected to take place Monday morning, according to Ann Keeling, chair of the Noncommunicable Disease Alliance (NCDA), the leading NGO that pushed for the Summit.

Ann Keeling photo courtesy of the International Diabetes Federation

However, she told me in an email, there will be time to address the conflict of interest issue in 2012, when the UN will be making decisions on both the establishment of partnerships as well as targets and indicators.

“The view of the NCDA is that the private sector, subject to ethical frameworks on conflict of interest, must be part of the solution, especially in implementation. We believe there should be a ‘triple partnership’ going forward – public/private/people with NGOs being the people and with far greater involvement from global to community level of people with NCDs.”

“Any senior scientist will tell you that the biggest conflict of interest he or she has doesn’t have anything to do with the [corporate or other] interests that they list on their PowerPoints or at the end of their publications,” Dr. Paul M. Ridker said recently during his presentation on the inflammatory hypothesis of atherosclerosis at the annual meeting of the International Society on Hypertension in Blacks. “It has to do with our individual belief in the biology of what we’re doing.”

For this reason, the lengthy disclosure slide that served as the backdrop to his talk was less relevant, he said, than his fundamental bias, which is his belief that inflammation is “part and parcel, if not the cause of, atherosclerosis.” That type of bias, not industry support, “is what drives my work, and it is what drives most scientists,” stressed Dr. Ridker of Brigham and Women’s Hospital in Boston.

Image courtesy of Flickr user Neubie by Creative Commons license.

Dr. Ridker’s contention is likely a nod to the diatribe that followed the publication of results from the 2008 JUPITER trial on the effects of rosuvastatin (Crestor) in which he and his co-investigators attributed a 44% reduction in cardiovascular events to the agent’s ability to both lower LDL cholesterol and reduce C-Reactive Protein (CRP) levels (N. Engl. J. Med. 2008 Nov. [359]: 2195-207).

Following the publication of the findings, cardiology colleagues questioned the interpretation and veracity of the data in the face of what they deemed to be an unacceptable degree of commercial bias. They were referring not only to the fact that the study was funded by AstraZeneca, the drug’s manufacturer, and that nine of the 14 authors disclosed financial ties to the company, but also that Dr. Ridker holds the legal patent on CRP testing technology. Without question, the skeptics argued, Dr. Ridker had much to gain from the acceptance of his research (Arch Intern Med. 2010 [170]:1032-36).

For his part, Dr. Ridker vigorously defended and continues to defend the quality of the JUPITER data. He has also introduced a salient argument: the conflicts of interest that have the most potential to bias research are not the tangible ones listed at the end of a paper. They are the intellectual and emotional ones that defy enumeration. He doesn’t argue against financial disclosures, but he does warn that they don’t tell the “whole story.”

I don’t really walk around with antennae out trying to detect pharmaceutical company influence on physicians, despite this being my second blog post on the topic in the past month. (See the earlier one here.) But I couldn’t help thinking about it when I arrived at the American Diabetes Association 2011 scientific meeting and found that the registration packet included a 40-page booklet produced by the ADA but focused on “Corporate Events.”

Cover of a book in the ADA attendee materials. (Photo by Sherry Boschert)

Most large medical conferences will have satellite symposia driven by drug companies, but I don’t think I’ve ever seen them given the same packaging treatment as the scientific sessions.

Why does this bother me? Well, the day after I returned from that meeting, the media widely reported on a study and several papers in The Spine Journal questioning the validity of years of industry-sponsored research that had led doctors to believe that a bone growth protein often used in spinal fusion surgeries was safe. The review led by Stanford University researchers concluded that bone morphogenetic protein may cause a variety of complications, even permanent or potentially fatal ones, at rates 10-50 times higher than reported. After the news coverage, the authors called out what they considered deceptive back-pedaling by the companies and a doctor who profited from it all.

Granted, that’s not the diabetes world, but having such an apparently cozy relationship between industry and the ADA probably isn’t a good thing in the end. Except that I imagine it might have helped pay for the truly delicious, healthy food they fed us in the press room.

On the other hand, there are signs of potential progress in disclosing drug company influence on the practice of medicine. Nearly all medical conferences I cover now religiously require speakers to list disclosures of conflicts of interest and make these accessible in printed form for all conference attendees. That’s a big improvement over the days when I’d have to request the information and spend a couple of hours flipping through the single three-ring binder containing disclosures.

And back at the American Diabetes Association meeting, I saw something else unusual that I had seen only once before, at the 2011 American Psychiatric Association meeting. In the Exhibit Hall, one of the pharmaceutical giants was giving away free fruit smoothies — nothing unusual in that. But the smoothie stand featured a sign saying the following:

“The cost of any refreshments, meals or educational items provided to U.S. licensed Healthcare Professionals attending this [company] Exhibit will be subject to public disclosure on [the company’s Website] as part of [the company’s] Healthcare Professional Disclosure policies, and may also be subject to disclosure by state governmental authorities pursuant to your state law. In order to comply with these requirements, please make your badge available to be scanned by an attendant as requested.

“If you hold a Healthcare Professional license in Minnesota, we are prohibited from providing you any refreshments or items of value due to your state limitations and ask that you do not partake in the hospitality provided.”

No need to feel sorry for Minnesota physicians, though. No such signs tried to dissuade them from filling up on coffee and lattes from numerous other company booths in the Exhibit Hall. Apparently smoothies may cross a “hospitality” threshold for disclosure that java does not.

My dream is far more modest than Dr. King’s but possibly just as ambitious. I have a dream that one day there will be a single, comprehensive repository of medical disclosures and conflicts of interest.

Our editorial policy is to include a statement about a researcher’s or physician’s potential conflicts of interest—even if it’s only to say that he or she has none. As a reporter, it makes my life….difficult. Presenters don’t always include this information in their talks. If they do, it’s in a slide that is visible for 0.4 seconds. So I have to track it down. Don’t get me wrong. I agree whole-heartedly that it is in everyone’s best interest to have this information. But I sure could do without all of the web searches and phone calls and, ultimately, wasted time.

I wonder if such a database—kind of like NIH’s Clinical Trials database—is possible to create, populate, and administrate? Who would do it and how could you compel researchers and physicians to include and update their information?